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Hair transplant procedures, when done right, with an experienced hair surgeon using the right tools and technique, should ideally have seamless and natural-looking results. However, when any of the above standards are not met, the result can be ineffective. Unfortunately, many men, celebrity and non-celebrity, have faced this issue. The added scrutiny of public attention, however, can contribute to a desire for more discrete procedures and subtle results. Older procedures, such as scalp reduction and flap procedures, can make this difficult.

Scalp reduction, a method no longer practiced by hair transplant surgeons today, was a popular restoration procedure in the 1980s. It involved the surgical removal of bald areas on the scalp. The bald skin of the scalp was excised, and the two ends on either side were stretched and sutured together. This was done to reduce the surface area of bald regions caused by androgenic alopecia, or male pattern hair loss.

The cutting, stretching and pulling involved in scalp reduction resulted in common side effects such as a loss of tightness in the scalp, creating a “stretch back” effect and visible signs of baldness, as well as hypoesthesia around the excision area and stretched skin around the sutures. Isolated patches of baldness are also common side effects of the procedure.

The conventional approach to FUE is to extract such hair individually with a punch tool from the back of the head, but this is limited in effectiveness due to both the natural thickness of the native hair there, which may look harsh on the temple and hairline, as well as the limited supply of hair in that area. An ideal solution would be to augment the donor supply with hair that matches the intended recipient area, from a non-head location. Most basic FUE tools, however, have trouble extracting such hair safely due to the angle of growth in non-head locations, such as the nape of the neck, beard, torso, leg, etc. A more advanced tool would be needed for such a procedure, capable of extracting all hair types from all hair locations.

Black celebrities can be at a disadvantage when it comes to hair transplant procedures, due to the severe curves of afro-textured hair underneath the skin, which straight, cylindrical punches often struggle to extract safely. Additionally, the tough skin texture, and strong tissue attachments to follicular units, often add to the challenge of removing these grafts from the surrounding skin. FUSS is a method of hair transplant in which a strip of hair-bearing scalp is cut from the back of the head. Hair follicles are then extracted from this strip of scalp and then implanted in the areas of hair loss. A drawback to this method is the visibility of the linear scar formed from the excision when wearing short hairstyles, as well as its tendency for it to stretch downward. Although FUSS is not as popular a procedure as it once was, due to the linear-scar free method of FUE, some African-American men may opt for the former due to past reputation black FUE procedures.

New advances in hair transplant technology present possible solutions for patients with afro-textured hair. One such advancement is the recent debut of the world’s first ultrasonic hair transplant on a patient in the aforementioned category. Ultrasonic frequencies, appropriately tuned for the patient’s skin tissue, combined with the use of a curved, sharp, punch designed for the curves of afro-textured hair, enabled an easier excision of the curly hair grafts from the tough skin and strong attachments.

The use of ultrasound in FUE may also be applied to other non-rotary tools, such as one designed for unshaven hair transplant, for a more efficient, discrete procedure — ideal for public figures as well as individuals who cannot take time off of work after the procedure.